Provider Demographics
NPI:1437169638
Name:LATIMER, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LATIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M. ELIZABETH
Other - Middle Name:
Other - Last Name:LATIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2401 PENNSYLVANIA AVE NW SUITE 400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3708
Mailing Address - Country:US
Mailing Address - Phone:202-625-4898
Mailing Address - Fax:202-625-4899
Practice Address - Street 1:2401 PENNSYLVANIA AVE NW SUITE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3708
Practice Address - Country:US
Practice Address - Phone:202-625-4898
Practice Address - Fax:202-625-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007600062Medicaid
MDF93600Medicare UPIN